Phantom pain

Under our skin there are receptors for many sensations: light and deep pressure,
movement, temperature and also for pain. Our pain receptors are free nerve
endings resting in one of the layers of our skin called the Dermis , they
detect any physical aversive stimulus. Once something has been detected, this
message is then relayed through a nerve pathway to the brain. These receptors
are located in all parts of our bodies, some parts, such as our fingers, contain
many more than other areas; these extremities are more capable of localizing a stimulus.
This concept is fairly straight forward - but how is it that a person can feel
pain in their fingers, for example, when their hand has already been
amputated? This is the concept of phantom pain.

Sensations from an amputated limb can manifest themselves in many different
ways, such as sensations of touch. For example, some amputees are able to feel
their arm resting on a table, their fingers able to feel the texture of the
table. Other times they can feel the absent limb in movement, possibly reaching
for a glass. Some report that the limb is drastically deformed or forshortened,
or that it remains rigid.

Sometimes, though, it is not merely a sensation that they feel, rather -
pain. Frequent complaints are: tingling, prickling and shooting pains, although this is not always the case. Some find themselves revistiting a pain
they had previous to the amputation, such as an ingrown toenail. The pain is
also not usually constant, some are reoccuring and others do not even begin
until long after the surgery.

Here are the some of the suggested causes of phantom pain (the list
is compiled from suggested causes discussed by amputees via the amputee listserv).

1. Prior experience with pain prior to amputation - If you have had
continued pain with joints or muscles etc prior to amputation, this is thought
to have a "phantom" effect post amputation.

2. Incorrect surgical procedure - Unless you live in a heavily
populated area or in a part of the world that has a high population of amputees,
chances are your surgeon (especially if traumatic amputation) may not be wholly
experienced in post-traumatic amputations.

Whilst it is somewhat unfair to point the finger for such things at the
inexperienced surgeon (at least your life was saved); incorrect surgical
procedures have caused some amputees problems for many years after the original
trauma.

3. Climatic conditions - Changes in weather, particularly related to changes in
air pressure and temperature can dramatically affect levels of phantom pain. Other than moving to
a different climate this is a hard one to avoid.

4. Stress - The cause of just about every ailment known ! Stressful
lifestyles lead to kinds of ailments and if your an amputee, phantom pain is
just another to add to the list.

5. Inactivity - Remaining in a relatively same position for long
periods of time. Office workers especially, poor posture really helps bring on
those phantoms. Make sure you are sat in the best possible position to keep blood flow to the amputated limb to a
maximum.

6. Periodic illness - Colds, flu, strep throat, infections,
virus'es
can increase the level of phantom sensation, sometimes to unbearable levels.
This is particularly noticeable for people who only notice phantom pain when ill. Not much you can do except either pump your self full of
drugs and sit this
out. But don't wait too long, 48 hours of constant phantom pain needs
prescription medication. More often than not phantom pain will cause you to
tense/tighten up therefore perpetrating even more phantom pain. In cases such as
this usually a one time shot of morphine or other signifcant pain killer will do
the trick.. See a doctor either
way.

Phantom Pain Relief Without Medication

(Condensed from The Christian Science Monitor)

Listed below are ways that members of Lower Extremity Amputees providing Support (LEAPS) of Kansas have found
helpful in relieving phantom pain.

These methods don't always work, of course, and what works for one person
may not work for another. Remember, check with your doctor if you have any
questions before trying these methods.

Wrap your stump in a warm, soft fabric, such as a towel. The warmth
will sometimes increase circulation. Poor circulation is thought to be one
cause of phantom pain.

Put ace wrap or shrinker sock on. If you have your prosthesis, put it
on and take a short walk.

If you have pain with the prosthesis on, take it and the prosthetic
sock off and put it back on after a few minutes. Sometimes the stump is
being pinched and changing the way it is on will relieve the pressure on
that nerve.

Change positions. If you are sitting, move around in your chair, or
stand up to let the blood get down into your stump.